Pietrow Paul K, Auge Brian K, Delvecchio Fernando C, Silverstein Ari D, Weizer Alon Z, Albala David M, Preminger Glenn M
Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Urology. 2002 Nov;60(5):784-8. doi: 10.1016/s0090-4295(02)01948-9.
To assess methods to improve the longevity and durability of flexible ureteroscopes by using the ureteral access sheath, 200-microm holmium laser fiber, and nitinol baskets or graspers during routine ureteroscopic procedures. Despite adequate advances in fiberoptics and endoscope design, the decreased size of currently available flexible ureteroscopes makes damage inevitable after repeated use. However, new auxiliary tools may be able to enhance ureteroscope durability.
The indications for performing flexible ureteroscopy were proximal ureteral stones (n = 32), renal calculi (n = 59), treatment of upper tract transitional cell carcinoma (n = 3), evaluation of hematuria or filling defect (n = 7), and treatment of ureteral strictures or ureteropelvic junction obstruction (n = 8). Using four new 7.5F flexible ureteroscopes, we prospectively evaluated the number of passes of each ureteroscope until more than 20 optical fibers were broken, more than a 25 degrees loss of deflection in either direction had occurred, or the instrument sustained injury requiring repair by the manufacturer.
One hundred nine flexible ureteroscopic procedures (average 27.5 procedures per instrument; range 19 to 34) were performed with the four new flexible ureteroscopes before being sent for repair. Adjuncts to reduce scope damage during these procedures were the use of the ureteral access sheath (n = 109), nitinol devices allowing lower pole stone retrieval (n = 27), and the 200-microm holmium laser fiber for stone fragmentation, tumor ablation, and incision of ureteropelvic junction/ureteral stenoses (n = 91). The average number of passes until more than 20 optical fibers were broken was 15.3 (range 12 to 20), until more than a 25 degrees loss of deflection occurred was 50.3 (range 42 to 66), or until the scope required repair was 66.7 (range 46 to 82).
Flexible ureteroscopy will be used increasingly to manage upper urinary tract pathologic findings. Historically, the number of procedures performed before a flexible ureteroscope requires repair averaged 6 to 15. By incorporating the new ureteroscopic accessories, such as nitinol devices, a ureteral access sheath, and the 200-microm holmium laser fiber into common practice, one can reduce the strain on these fragile 7.5F endoscopes, thereby maximizing their longevity.
评估在常规输尿管镜检查过程中，通过使用输尿管通路鞘、200微米钬激光光纤以及镍钛合金网篮或抓取器来提高软性输尿管镜使用寿命和耐用性的方法。尽管光纤和内窥镜设计有了足够的进步，但目前可用的软性输尿管镜尺寸减小，反复使用后损坏不可避免。然而，新的辅助工具可能能够提高输尿管镜的耐用性。
进行软性输尿管镜检查的适应证包括输尿管上段结石（n = 32）、肾结石（n = 59）、上尿路移行细胞癌的治疗（n = 3）、血尿或充盈缺损的评估（n = 7）以及输尿管狭窄或输尿管肾盂连接部梗阻的治疗（n = 8）。我们使用4条新的7.5F软性输尿管镜，前瞻性评估每条输尿管镜在超过20根光纤断裂、任一方向偏转损失超过25度或器械出现需要制造商维修的损伤之前的使用次数。
在将这4条新的软性输尿管镜送去维修之前，共进行了109例软性输尿管镜检查（平均每条器械27.5例；范围19至34例）。在这些操作过程中，用于减少内镜损伤的辅助工具包括使用输尿管通路鞘（n = 109）、用于下极结石取出的镍钛合金器械（n = 27）以及用于结石碎石、肿瘤消融和输尿管肾盂连接部/输尿管狭窄切开的200微米钬激光光纤（n = 91）。在超过20根光纤断裂之前的平均使用次数为15.3次（范围12至20次），在超过25度偏转损失发生之前为50.3次（范围42至66次），在器械需要维修之前为66.7次（范围46至82次）。
软性输尿管镜将越来越多地用于处理上尿路病变。从历史上看，软性输尿管镜在需要维修之前平均进行的操作次数为6至15次。通过将新的输尿管镜配件，如镍钛合金器械、输尿管通路鞘和200微米钬激光光纤纳入常规操作，可以减轻这些脆弱的7.5F内镜的压力，从而最大限度地延长其使用寿命。
